I70.523

Billable

Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, bilateral legs

HCC Category Mapping

V28HCC 264 — Vascular Disease with Complications

0.356

V24HCC 108 — Vascular Disease

0.297

ESRDHCC 108 — Vascular Disease

0.000

What This Code Means

This code describes a condition where fatty deposits have built up in artificial blood vessel grafts (made from non-human biological material) in both legs, causing pain even when the person is resting. The blocked grafts restrict blood flow to the leg tissues.

Coding Tips

•Verify documentation specifies bilateral involvement (both legs) and confirms rest pain is present, as these are required elements for this specific code
•Ensure the graft material is documented as nonautologous biological (not the patient's own tissue) and confirm the location is the extremities to select the correct code variant

Clinical Significance

This code captures atherosclerosis of a nonautologous biological bypass graft with rest pain, indicating critical limb ischemia where blood flow is insufficient even at rest. Rest pain represents a limb-threatening condition requiring urgent vascular evaluation and intervention to prevent progression to tissue loss or gangrene. The code corresponds to Fontaine Stage III (rest pain), indicating critical limb ischemia with pain at rest. Documentation and coding of this condition are important for reflecting the severity of the patient's vascular disease burden.

Documentation Requirements

✓Documentation of the type of bypass graft as nonautologous biological (must distinguish from autologous vein, nonautologous biological, or synthetic/nonbiological grafts)
✓Clinical evidence of atherosclerosis affecting the bypass graft (imaging, angiography, or clinical assessment)
✓Documentation of pain occurring at rest (not only with ambulation), including character and location
✓Vascular study results supporting critical limb ischemia (such as ankle-brachial index below 0.4 or absent pedal pulses)
✓Clinical differentiation from neuropathic pain or other non-vascular causes
✓Documentation confirming bilateral involvement with findings described for each extremity

Commonly Confused Codes

I70.4xx — Autologous vein bypass graft codes; use when the graft is the patient's own harvested vein, not donor or animal tissue I70.6xx — Nonbiological bypass graft codes; use when a synthetic graft material (such as Dacron or polytetrafluoroethylene) is used rather than biological tissue I70.2xx — Native artery atherosclerosis codes; use when no bypass graft is present and disease is in the patient's own arteries G89.29 — Other chronic pain; do not use for ischemic rest pain which has a specific vascular code M79.609 — Pain in unspecified limb; too nonspecific when the cause is known peripheral arterial disease

Code Hierarchy

└I70Atherosclerosis └I70.5Atherosclerosis of nonautologous biological bypass graft(s) of the extremities └I70.52Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain └I70.523Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, bilateral legs

└I70.523Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, bilateral legs